CO-1

Booster Dose of

Janssen COVID-19 Vaccine (Ad26.COV2.S) 

Following Primary Vaccination

Janssen Pharmaceutical Companies of Johnson & Johnson

Advisory Committee on Immunization Practices (ACIP)

October 21, 2021
CO-2

Booster Dose of

Janssen COVID-19 Vaccine (Ad26.COV2.S) 

Following Primary Vaccination

Penny M. Heaton, MD

Global Therapeutic Area Head Vaccines

Janssen Pharmaceutical Companies of Johnson & Johnson
CO-3

◼ Initial Phase 3 study evaluated single-dose for pandemic response, globally

◼ Durable protection from single dose

◼ In the US, 74% efficacy against severe disease and 

70% efficacy against all symptomatic disease

◼ Efficacy persisted for at least 6 months 

◼ Unique immunoprofile with antibody titers that peak later and persist; 

durable cellular immunity with persistent responses

Ad26.COV2.S: Unique Development Strategy, 

Durable Efficacy, Breadth of Immune Response

Durability is clear, room to boost protection against symptomatic infection

• Homologous boost of Ad26.COV2.S aligns with US priority to optimally protect 

individuals against any COVID-19 infection
CO-4

Clinical Program Supports Booster Dose is Safe, Increases 

Protection, Including Against Symptomatic COVID-19

> 9000 Received Ad26 Booster Dose in Randomized Clinical Trials

Booster dose is safe and well-tolerated

Rapid rise in antibodies after booster dose

• Reflects anamnestic response, consistent with a booster dose

• Booster dose at 6 months provided 12-fold increase in antibodies, more potent than at 2 months

Booster dose increased efficacy against COVID-19

• Efficacy against symptomatic disease in the US increased to 94% and to 74% globally

• Complete protection against severe/critical COVID-19 globally

Protection against variants of concern tested, including Delta

• Large RWE study of single-dose showed similar efficacy against COVID-19 hospitalizations after 

Delta became dominant in US

• Booster at 6-months increased breadth of immune response inducing neutralizing antibody titers 

against variants of concern
CO-5

COV3001 (Single-dose)

Final Analysis of Double-Blind Period*

• Following EUA, protocol allowed crossover for participants on placebo

• Median follow up: 4 months

• 23% of participants had follow up of ≥ 6 months

*Data cut off date of July 9, 2021

3001
CO-6

COV3001: Durable VE for Symptomatic COVID-19 in US

0

0

Time Since Vaccination (days)

Vaccine Efficacy 

in United States

%

100

90

80

70

60

50

40

30

20

10

Day 28

post-dose

Numbers at risk

Ad26.COV2.S

Placebo

95% point-wise CI

30 60 90 120 150 180 210

9153 8797 17553 6130 3180 1180 446 153

9119 8605 7127 5665 2700 944 385 162

3001

• US: 70% VE against symptomatic COVID-19 > Day 28

• RWE cohort study showed similar level of protection in US through Delta surge
CO-7

COV3001: Persistent VE Against Severe COVID-19

*Primary endpoint COV3001

Baseline-seronegative participants, per-protocol (PP) analysis set; based on hazard ratio of severe/critical COVID-19

0

0

Time Since Vaccination (days)

Vaccine Efficacy

Global

%

100

90

80

70

60

50

40

30

20

10

Numbers at risk

Ad26.COV2.S

Placebo

95% point-wise CI

30 60 90 120 150 180 210

19589 19134 17521 15202 9815 5046 3796 1260

19562 19230 17764 15591 10284 5432 4045 1307

Day 28

post-dose

• 75% VE against severe/critical COVID-19 > Day 28*

• Protection against severe disease in context of variants remained strong

3001
CO-8

COV3001: VE for Symptomatic COVID-19

Baseline-seronegative participants, per-protocol analysis set protocol analysis set; based on hazard ratio of severe/critical COVID-19

0

0

Time Since Vaccination (days)

Vaccine Efficacy

Global

%

100

90

80

70

60

50

40

30

20

10

Day 28

post-dose

Numbers at risk

Ad26.COV2.S

Placebo

95% point-wise CI

30 60 90 120 150 180 210

19562

19589 18902 17052 14622 9328 4745 3531 1098

19111 17540 15290 10033 5256 3887 1193

3001

• 53% VE against symptomatic COVID-19 > Day 28

• 3 variants with VE < 50% became prevalent outside US during this period
CO-9

Immune Responses Persist Over Time, Following a Single Dose*

10

100

1000

10000

1 29 57 71 85 239

Neutralizing 

Antibody

GMT (95% CI)

Above LLOQ

224

LLOQ = lower limit of quantification

N 24 25 24 24 22

% Responders 96

100 100 100 95

25

Days Post Primary Vaccination

Primary vaccination 

5x1010vp

% Detectable antibodies

Humoral Immune Response

Neutralizing Antibodies

Cell-Mediated Immune Response 

CD8+ T Cells

0.01

0.1

1

10

1 15 29 57 71

N

Median

% Positive

40

0

3

39

0.05

46

38

0.12

61

39

0.15

82

38

0.15

74

Days Post Primary Vaccination

Primary vaccination 

5x1010vp

Placebo

% IFN+ / 

CD8+ T cells

*Similar trend seen for both 18-55 yrs and ≥ 65 yrs age groups
CO-10

Efficacy of Booster After Single-Dose Primary 

Regimen of Ad26.COV2.S

• “Booster dose” reflects robust immune response to single dose, 

anamnestic response to second dose
CO-11

◼ Large (N=31,300), global, randomized placebo-controlled trial 

conducted in 9 countries, 3 continents 

◼ Study allowed unblinding following EUA

◼ Participants on placebo offered vaccine 

◼ 53% received booster dose during double-blind period

◼ 25%* evaluable for efficacy ≥ 60 years 

◼ Median follow-up after booster dose: 36 days (0 to 172 days)

◼ 29% (n > 4245) of participants had follow up ≥ 2 months

COV3009: Evaluated Efficacy of Ad26 Following 

Administration of Booster 2 Months After First Shot

3009

*Per Protocol data set
CO-12

VE% (95% CI)

0 20 40 60 80 100

Country Post-dose Study Day

Symptomatic COVID-19 

Ad26.COV2.S vs Placebo

VE

(95% CI)

United 

States

3001: Post-dose 1 Day > 28 70% (61, 77)

3009: Post-booster Day > 71 94% (59, 100)

COV3001 and COV3009: US and Global VE Against Symptomatic 

COVID-19 for Single Dose vs Booster after 2 Months

VE% (95% CI)

3001 Final analysis cutoff date: July 9, 2021 (all), June 16, 2021 (US) 

3009 Final analysis cutoff date: June 24, 2021 (all), June 9, 2021 (US) 

Global* 

(All)

3001: Post-dose 1 Day > 28 53% (47, 58)

3009: Post-booster Day > 71 75% (55, 87)

3001

3009

0 20 40 60 80 100

*Primary endpoint for 3001 and 3009 (VE moderate to severe = VE symptomatic)
CO-13

COV3009: Protection Against Severe Outcomes 

PP At Risk Set

Global

> Day 71 

(> 14 Days Post-Booster)

Ad26.COV2.S

(N = 6,024)

Placebo

(N = 5,615)

VE %

(95% CI)

Severe COVID-19 0 8

100%

(33, 100)

COVID-19-related hospitalization 0 5 N/A

COVID-19-related death 0 1 N/A

3009 Final analysis cutoff date: June 24, 2021

3009
CO-14

Immunogenicity Following 

Booster Dose of Ad26.COV2.S
CO-15

Booster Timing

Age

(yrs)

Sample Size

S ELISA wtVNA psVNA

2 months

18-55 181 99* 5 (Original, Alpha, Beta, Gamma, 

Delta, Epsilon, Kappa)

≥ 65 79 65 -

3 months

18-55 27 22 -

≥ 65 101 40 -

6 months 18-55 29 -

17 (B1, Alpha, Beta, Gamma, Delta, 

Lambda)

Clinical Immunogenicity Studies Supporting 

Ad26.COV2.S Booster Dose

*Variant wtVNA N=6 (Alpha, Beta)

Data from studies COV1001, COV1002, COV2001; Sample sizes depicted are at baseline 
CO-16

COV1001 and COV2001: Benefit of Booster Dose 

Higher When Given at 6 Months or Later

*Data from COV2001 Group 1 

**Data from CVO2001 Group 9 / post-dose 1, data from parallel group

***Data from COV1001 Cohort 2a

Fold-Increase in 

Spike Binding 

Antibody Titers 

28 Days Post 

Boost vs 28 Days 

Post Dose 1

Booster at 

2 Months*

(n=52) (n=27) (n=17) (n=29) (n=20)

Booster at 

3 Months**

Booster at 

6 Months***

18-55 years

4.6

5.6

12.0

0

2

4

6

8

10

12

14

18-55 18-55 18-55

(n=51) (n=27) (n=17)
CO-17

Safety Results of Ad26.COV2.S Booster

Macaya Douoguih, MD, MPH

Head of Clinical Development & Medical Affairs, Vaccines

Janssen Pharmaceutical Companies of Johnson & Johnson
CO-18

Cumulative Exposure to Ad26.COV2.S Booster 

After Single-Dose Primary Regimen, > 9000

Interval Between Primary Regimen and Booster

Study (Dose Level) 2 months 3 months ≥ 6 months

COV1001 (5 x 1010) 190 77* 19

COV1002 (5 x 1010) 91 0 0

COV2001 (5 x 1010) 137 51 0

COV2008 (5 x 1010) 0 0 127** (blinded)

COV3009 (5 x 1010) 8,655 0 0

Total by Interval 9,073 128 19

Overall Total 9,220

*Some participants received second dose with 3-month rather than scheduled 2-month interval because of a study pause

**370 participants received booster in 3:3:1 ratio at dose level of 5 x 1010, 2.5 x 1010, or 1 x 1010; Dose-level data remain blinded 
CO-19

Reactogenicity of Booster Dose at 2 Months

Study COV3009
CO-20

COV3009: Lower Systemic Reactogenicity with 

Booster at 2 Months Compared to Primary Dose

COV3009; Safety Subset

≥ 1 

Systemic AE Fatigue Headache Myalgia Nausea Fever

0%

20%

40%

60%

80%

100%

Grade 1

Grade 2

Grade 3

≥ 1 

Systemic AE Fatigue Headache Myalgia Nausea Fever

0%

20%

40%

60%

80%

100%

Grade 1

Grade 2

Grade 3

0.8% 0.4%

0.1%

0.9%

1.0%

0.3%

0.5%

0

0.5%

0.2% 0.5%

0

0.9%

1.0%

0.4%

2.5%

1.8% 1.2%

0.7%

0.1%

0.1%

0.6%

1.1%

0.1%

18-59 Years

Primary N = 1,784; Booster N = 1,164 

≥ 60 Years

Primary N = 1,231; Booster N = 395

3009
CO-21

Reactogenicity of Booster Dose at 6 Months

Study COV1001 and Study COV2008
CO-22

COV1001: Systemic Reactogenicity 

of Booster at 6 Months vs Primary Dose

≥ 1 

Systemic AE Fatigue Headache Myalgia Nausea Fever

0%

20%

40%

60%

80%

100%

Grade 1

Grade 2

Grade 3

0

3.4%

0

3.4%

0 0

0

0 0

0

0

0

COV1001: 18-55 Years

Primary N = 29; Booster N = 19
CO-23

◼ Ongoing randomized double-blind study of participants enrolled in 

Study 3001 evaluating three Ad26.COV2.S booster dose levels 

≥ 6 months following primary vaccination with Ad26.COV2.S

◼ 127 estimated to have received 5 x 1010 vp

◼ Blinded 7-day safety data available on 83 participants 

(N~32 ≥ 60 years) 

◼ Dose-level data remain blinded; however, no Grade 3 systemic 

reactogenicity events have been reported

COV2008: Preliminary Blinded Systemic 

Reactogenicity of Booster at ≥ 6 Months
CO-24

Unsolicited Adverse Events

Study COV3009
CO-25

COV3009: Similar Rates of Unsolicited AEs 

Between Groups

*Reported through June 25, 2021

3009

Ad26.COV2.S Placebo

Safety Subset – Dose 1 N = 3,015 N = 3,052

Any AE 454 15.1% 332 10.9%

Safety Subset – Dose 2 N = 1,559 N = 1,425

Any AE 159 10.2% 120 8.4%

Full Analysis Set (FAS) N = 15,705 N = 15,588

Any MAAE 1033 6.6% 1003 6.4%

Any SAE 104 0.7% 136 0.9%

Non-COVID-19-related 98 0.6% 104 0.7%

Any death* 4 < 0.1% 13 0.1%

COVID-19-related 0 0 6 < 0.1%
CO-26

Adverse Events of Interest / Special Interest

Study COV3009
CO-27

◼ COV3009: Two cases of thrombosis with thrombocytopenia during follow-up

◼ Ad26.COV2.S: DVT with thrombocytopenia on Day 100 post-vaccination

◼ Placebo: DVT (Day 27) and PE (Day 29) with thrombocytopenia

◼ Neither case definitive TTS based on CDC criteria

◼ Post-marketing data for AstraZeneca COVID-19 vaccine in UK

◼ Dose 1: 24.9 million; Dose 2: 24.0 million

◼ Estimated rate of blood clots with concurrent low platelets

◼ Dose 1 (or unknown): 15.1 cases per million; Dose 2: 1.9 cases per million

◼ Overall case fatality rate: 17% (66 deaths after first dose, 6 deaths after second dose)

◼ UK Government interpretation: “no indication of an increased risk of these events after the 

second dose in any age group"

Potential Cases of Thrombosis with 

Thrombocytopenia Syndrome (TTS)

https://www.gov.uk/government/publications/coronavirus-covid-19-vaccine-adverse-reactions/coronavirus-vaccine-summary-of-yellow-card-reporting 
CO-28

COV3009: No Increase in Other Adverse Events of 

Interest with Booster Dose

Adverse Event of Interest

Within 28 Days of Primary Dose Within 28 Days of Booster Dose

Ad26.COV2.S

(N=15,705)

Placebo

(N=15,588)

Ad26.COV2.S

(N=8,646)

Placebo

(N=8,043)

Embolic and thrombotic events (SMQ) 2 (< 0.1%) 6 (0.1%) 3 (< 0.1%) 3 (< 0.1%)

Convulsions / seizures 0 0 0 0

Tinnitus 4 (< 0.1%) 2 (< 0.1%) 2 (< 0.1%) 2 (< 0.1%)

Guillain-Barre Syndrome 0 0 0 0

Facial paralysis 1 (< 0.1%) 2 (< 0.1%) 1 (< 0.1%) 0

Arthritis 24 (0.2%) 12 (0.1%) 4 (< 0.1%) 5 (0.1%)

3009
CO-29

◼ Similar reactogenicity and safety profile for homologous boost at 

2 or 6 months vs single-dose primary regimen

◼ Local AEs similar regardless of booster timing

◼ Systemic AEs lower with booster at 6 months than 2 months

◼ No new safety signals for AEs, SAEs, or AEs of interest with booster

◼ Global surveillance suggests rare TTS events with viral vector vaccine 

are less frequent with second dose than first dose 

◼ Ongoing and planned post-authorization studies will be revised to 

incorporate follow-up of booster in addition to primary doses

Conclusions on Safety of Homologous Boost of 

Ad26.COV2.S
CO-30

Conclusion

Penny M. Heaton, MD

Global Therapeutic Area Head Vaccines

Janssen Pharmaceutical Companies of Johnson & Johnson
CO-31

Totality of Data Support Safety, Efficacy of Homologous 

Booster Dose of Ad26.COV2.S

Booster dose safe and well tolerated

• Large safety data base with > 9,000 exposures Safety

Data support a homologous booster dose with Ad26.COV.2.S

Boost 

Humoral responses persisted after a single-dose of Janssen vaccine

• Unique immunologic profile

• Cell-mediated immunity and nAbs all important contributors to protection Immunogenicity

Administration of booster dose results in greater protection against COVID-19

• Efficacy against symptomatic infection boosted to 94% in US

Vaccine Efficacy • Complete protection against severe disease globally
CO-32

◼ Provides flexibility for administering booster dose of Ad26 

Homologous Boost with Ad26.COV2.S Helps 

Further Protect Individuals from COVID-19

VRBPAC Recommendation

▪ Available data support the safety and effectiveness of Janssen 

COVID-19 Vaccine for use under EUA as a booster dose in 

individuals 18 years and older at least 2 months after a single 

dose primary vaccination
CO-33

Booster Dose of

Janssen COVID-19 Vaccine (Ad26.COV2.S) 

Following Primary Vaccination

Janssen Pharmaceutical Companies of Johnson & Johnson

Advisory Committee on Immunization Practices (ACIP)

October 21, 2021